Background: Right-ventricular after-load, reflected by pulmonary-artery systolic pressure (PASP), is a key determinant of prognosis in chronic obstructive pulmonary disease (COPD). Whether routine spirometry reliably signals haemodynamic stress remains debated. Objective: To quantify concordance between spirometric severity (GOLD grades) and echo-derived PASP categories; to derive cut-points of FEV₁ %-predicted for identifying clinically relevant PH; and to propose a combined lung–heart grid for integrated staging. Methods: In 126 clinically stable COPD out-patients (June 2016–May 2019) we compared GOLD 2024 grades (1–4) with PASP strata (normal 55). PASP was obtained from the tricuspid-regurgitant jet; mean PAP estimated with Chemla’s regression. Concordance was assessed by weighted Cohen’s κ. Receiver-operating-characteristic (ROC) analysis evaluated FEV₁ %- predicted for detecting PASP > 40 mmHg (moderate-severe PH). Results: Median FEV₁ was 51 %-predicted; median PASP 34 mmHg. Grade-to-stratum agreement was substantial (κ = 0.72, 95 % CI 0.61–0.82). Misclassification occurred in 14 %: 9 “lung-mild/heart-severe” and 9 “lung-severe/heart-mild”. ROC analysis yielded area-under-curve 0.81 (95 % CI 0.73–0.88). An FEV₁ threshold 40 mmHg. Incorporating PaO₂ < 65 mmHg improved AUC to 0.85 (p = 0.04). We propose a four-quadrant Lung–Heart Severity Grid that identifies discordant phenotypes warranting targeted imaging or cardiopulmonary exercise testing. Conclusions: Spirometric severity and PASP demonstrate good—but not perfect—concordance. FEV₁ %- predicted < 48 % flags patients likely to harbour moderate-to-severe pulmonary hypertension, however, in this study 1 in 7 remain misclassified. A simple Lung–Heart grid may aid comprehensive staging and timely referral for right-heart evaluation in COPD clinics.
Dhandoria et al. (Wed,) studied this question.